Despite the high burden exerted, Plasmodium vivax has been a ‘neglected’ human malaria parasite. In the last decade, anaemia is one the most prevalent severe malaria manifestations worldwide. Recently, we have obtained first unequivocal evidence of the presence of P. vivax parasites in the bone marrow of an infected patient. Moreover, transcriptional analysis of bone marrow aspirates during infection and at convalescence of this same patient demonstrated transcriptional changes of miRNAs related to erythropoiesis. Also, it is known that P. vivax infections cause bone marrow dyserythropoiesis and ineffective erythropoiesis.

Anaemia in malaria is further exacerbated through the destruction of uninfected red blood cells. Destruction of red blood cells is a function of the spleen, our only blood filtering organ. Splenomegaly is a hallmark of human malarial infections and the degree of anaemia is related to the size of the spleen. Moreover, it has been established that in benign red blood cell disorders inducing anaemia, there is extramedullary haematopoiesis in this organ to compensate for the lack of red blood cells.